Racial Differences in Clinical Progression Among Medicare Recipients After Treatment for Localized Prostate Cancer (United States)

Cohen, Jacob; Schoenbach, Victor J.; Kaufman, Jay S.; Talcott, James A.; Schenck, Anna P.; Peacock, Sharon; Symons, Michael; Amamoo, M. Ahinee; Carpenter, William R.; Godley, Paul A.

doi:10.1007/s10552-006-0017-7

Cited by 50 publications

(43 citation statements)

References 20 publications

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“…We also examined whether differential access to health care may affect prognosis but found no real differences in the hazard ratios from studies where men had access to free health care as compared to studies of men without free access. This is consistent with a recent report 18 that also found that Black men had worse disease free survival among Medicare recipients (excluded from our meta-analysis due to an incompatible outcome measure). From the perspective of the present review this suggests that even when financial barriers to health care do not exist, there remain Black-White differences in prognosis.…”

Section: Discussionsupporting

confidence: 93%

Investigating Black‐White differences in prostate cancer prognosis: A systematic review and meta‐analysis

Evans

Metcalfe

Ibrahim

et al. 2008

Intl Journal of Cancer

125

107

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The case-fatality rate following a diagnosis of prostate cancer is higher for Black men compared to White men. How this elevated rate arises is uncertain, with differences in disease biology, presentation, treatment and comorbidity having been suggested. A systematic search was conducted for articles that reported ethnic differences in overall-survival, prostate cancer specific survival (PSS) or biochemical recurrence. 48 articles met the inclusion criteria. Black men had worse overall survival (risk ratio 1.35, 95% CI 1.23-1.48) but this was not due to comorbidity alone as PSS and risk of biochemical recurrence were also elevated (1.29, 95% CI 1.13-1.47 and 1.34, 95% CI 1.23-1.46, respectively). Studies adjusting for clinical predictors and socioeconomic variables no longer supported a difference in overall survival (1.01, 95% CI 0.88-1.16), but continued to find an increased risk amongst Black men for PSS (1.13, 95% CI 1.00-1.27) and biochemical recurrence (1.25, 95% CI 1.11-1.41). Similar results were seen for studies from the pre-PSA era and free-health care settings. In contrast to others, studies of metastatic cancer did not find evidence of BlackWhite differences (p for interaction 5 0.01). In conclusion, Black men had a poorer prognosis which was not fully explained by comorbidity, PSA screening, or access to free health care, although few studies measure these factors well. Either management differences for local disease and/or biological differences may be behind Black-White differences in prostate cancer prognosis. ' 2008 Wiley-Liss, Inc.Key words: prostate cancer; ethnicity; prognosis; meta-analysis It is relatively uncontroversial to state that Black men have a greater incidence of prostate cancer than white men.1-3 The picture is less clear with regards ethnic differences in case fatality following prostate cancer diagnosis. There are several reasons why Black men may have a worse prognosis than their White counterparts.4,5 Some of these reasons may reflect socio-cultural differences that are amenable to intervention, whilst others may reflect genuine racial differences in cancer biology. These 2 types of explanations are not mutually exclusive and both may operate simultaneously.Possible socio-cultural explanations are: (i) Black men may have worse access to health care and therefore present later in the natural history of the disease at a more advanced stage. 6 (ii) In the US, more White men in the past have been diagnosed through screening.7 This will artefactually increase survival differences due to the phenomena of ''lead-time'' and ''length-time'' biases. (iii) Black men may be subject to differences in clinical management such that they are less aggressively investigated or treated. 8,9 (iv) Black men are more likely to have lower socioeconomic status, increased comorbidity and overall reduced life-expectancy compared to White men.10 These factors will increase the apparent difference in mortality rates even if there were no ethnic differences in the natural history of prostate cancer. How...

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Section: Discussionsupporting

confidence: 93%

Investigating Black‐White differences in prostate cancer prognosis: A systematic review and meta‐analysis

Evans

Metcalfe

Ibrahim

et al. 2008

Intl Journal of Cancer

125

107

View full text Add to dashboard Cite

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“…Another meta-analysis of prostate cancer articles [26], published from 1968 to 2007, failed to demonstrate prostate-cancer-specific survival differences between Black and White patients. It has been previously demonstrated in a Surveillance Epidemiology and End Results (SEER) data analysis that there are racial differences in disease-free survival for prostate cancer patients, with Black patients experiencing shorter disease-free survival compared to White, Hispanic, or Asian patients [15]. One possibility that we failed to demonstrate a racial disparity in our analysis may be that by grouping multiple races into a broad non-White category, that differences between Black, White, Hispanic, and Asian races may obscure potential effects.…”

Section: Discussionmentioning

confidence: 99%

Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials

Bae

Movsas

et al. 2011

Support Care Cancer

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Prostate cancer is the most common visceral cancer in men in the USA. The stratification of prostate cancer risk is currently modeled solely on pathologic prognostic factors including PSA and Gleason Score. Independent of these pathologic prognostic factors, our paper describes the central sociodemographic factor of being single as a negative prognostic indicator. Single men are at high risk of poorer outcomes after prostate cancer treatment. Intriguingly, in our group of patients, race was not a significant prognostic factor. The findings in this paper add to the body of work that describes important sociodemographic prognostic factors that are currently underappreciated in patients with cancer. Future steps will include the validation of these findings in prospective studies, and the incorporation of clinical strategies that identify and compensate for sociodemographic factors that predict for poorer cancer outcomes.

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“…A US study of SEER and Medicare data on patients aged 65-84 years with clinically localized prostate cancer [22] showed racial disparities in prostate cancer-specific survival after adjustment for covariates (age, co-morbidity, SEER site, education, income, marital status, stage, and tumor grade), with the survival gap being largest for patients undergoing surgery. Black men who were treated surgically also had earlier recurrence of their prostate cancer [23].…”

Section: Discussionmentioning

confidence: 99%

Ethnic differences in prostate cancer survival in New Zealand: a national study

Sneyd

2008

Cancer Causes Control

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Racial Differences in Clinical Progression Among Medicare Recipients After Treatment for Localized Prostate Cancer (United States)

Cited by 50 publications

References 20 publications

Investigating Black‐White differences in prostate cancer prognosis: A systematic review and meta‐analysis

Investigating Black‐White differences in prostate cancer prognosis: A systematic review and meta‐analysis

Impact of marital status and race on outcomes of patients enrolled in Radiation Therapy Oncology Group prostate cancer trials

Ethnic differences in prostate cancer survival in New Zealand: a national study

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